Sr. Risk & Quality Performance Manager (Remote)

Lensa; Detroit (MI); Remote; USD 80,000 - 110,000; Full time

Job summary

An established industry player is looking for a Sr. Risk & Quality Performance Manager to lead vital projects within their Risk & Quality Solutions team. This role is pivotal in enhancing program outcomes through effective collaboration with various departments and stakeholders. You will manage data collection strategies, ensure timely program delivery, and resolve complex issues using your analytical skills. If you have a strong background in healthcare risk adjustment and project management, this is an exciting opportunity to make a significant impact in a dynamic environment.

Qualifications

• 4+ years in program/project management in risk adjustment and/or quality.
• Experience with data analysis using technical tools.
• Strong quantitative and problem-solving skills.

Responsibilities

• Manage Risk/Quality data collection strategies and analytics.
• Ensure programs are delivered on time and within scope.
• Proactively communicate risks and issues to stakeholders.

Skills

Program/Project Management

Data Analysis

Microsoft Azure

SQL Server

Microsoft Office Suite

Healthcare Knowledge

Quantitative Skills

Verbal and Written Communication

Collaboration

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Excel

Microsoft Project

Job description

Sr. Risk & Quality Performance Manager (Remote)

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Job Description

Job Summary

The Sr. Risk & Quality Performance Manager is a tactical execution role that will lead specific projects supporting Molina’s Risk & Quality Solutions (RQS) team and program outcomes. This position collaborates with various departments and stakeholders within Molina to plan, coordinate, and manage resources, executing performance improvement initiatives aligned with RQS’s strategic objectives.

Job Duties

1. Collaborate with Health Plan Risk and Quality leaders to improve outcomes by managing Risk/Quality data collection strategies, analytics, and reporting, including risk/quality rate trending and forecasting, provider performance, CAHPS, survey analytics, health equity, SDOH, and engaging external vendors.
2. Ensure programs are delivered on time, within scope, and within resource constraints.
3. Manage Risk/Quality data ingestion activities and strategies, including optimization of EHR/HIE and supplemental data impact.
4. Meet customer expectations, establish and maintain effective relationships, and gain trust and respect.
5. Resolve complex problems through project management, data analytics, and stakeholder collaboration.
6. Manage program changes and ensure alignment with goals.
7. Handle complex assignments and update leadership as projects develop.
8. Draw actionable conclusions and make decisions collaboratively.
9. Ensure program deliverables meet quality standards and regulatory requirements.
10. Partner with teams to ensure data quality and identify opportunities to close care gaps.
11. Identify risks and implement mitigation strategies.
12. Proactively communicate risks and issues to stakeholders and leadership.
13. Create, review, and approve program documentation, ensuring it is updated and accessible.
14. Proactively communicate regular status reports, highlighting progress, risks, and issues.
15. Function as a team SME and support other requests as needed.

Job Qualifications

Required Education

Bachelor’s degree or equivalent experience.

Required Skills & Experience

• 4+ years in program/project management in risk adjustment and/or quality.
• 4+ years supporting HEDIS engine activity, risk adjustment targeting, and reporting systems.
• Data analysis experience using technical tools to answer risk and quality questions.
• Experience with queries in Microsoft Azure or SQL Server.
• Proficiency in Microsoft Office Suite, especially Excel and Project.
• Healthcare experience with strong risk adjustment and/or quality knowledge.
• Experience partnering with leadership in complex organizations.
• Strong quantitative and problem-solving skills.
• Ability to communicate complex concepts clearly.
• Excellent verbal, written, and presentation skills.
• Energetic and collaborative attitude.

Preferred Education

Graduate degree or equivalent experience.

Preferred Experience

• Supporting leadership in cross-functional, matrixed organizations.
• SQL fluency.
• Knowledge of healthcare claim elements (CPT, LOINC, SNOMED, etc.).
• Success in roles impacting Risk Adjustment and HEDIS.

Preferred Certifications

PMP, Six Sigma Green/Black Belt or similar coursework preferred.

To apply, current Molina employees should use the intranet. Molina offers competitive benefits. EOE M/F/D/V.